A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries.

Abstract

Following the Term Breech Trial, vaginal breech deliveries are rarely undertaken in Australia. Some women choose to have a breech delivery following counselling, while others will present in labour with an undiagnosed breech. Clinicians need to be skilled in vaginal breech delivery despite this being a rare clinical situation. Simulation training provides a means by which uncommon clinical situations can be practised. This study aims to determine if the introduction of a simulation-based training course is associated with an improvement in the management of vaginal breech delivery and neonatal outcomes. Cases of term vaginal breech delivery five years prior to introduction of In Time training (2001-2005) and five years after In Time training (2007-2011) were identified in a tertiary obstetric hospital (King Edward Memorial Hospital, Perth). There were 136 women identified in the pre-training (2001-2005, n=56) and post-training (2007-2011, n=80) groups. Case note review was undertaken to gather information. Apgar scores of <7 at five minutes were higher in the post-training cohort (8.8% vs 0%, P=0.041). Arterial and venous pH readings were similar between cohorts, with a non-significant trend toward improvement in the post-training cohort. Special care nursery admissions and length of hospital stay were unchanged. The primary accoucheur was more likely to be a consultant (35.0% vs 16.4%) in the post-training cohort. Appropriate manoeuvres were more likely to be used in the post-training cohort (52.5% vs 44.6%). Obstetric In Time simulation training improved seniority of accoucheur and documented appropriate manoeuvres in the management of term vaginal breech delivery.